The need for digitization in Critical Care

Recently, there are way too many discussions are ongoing around #GenerativeAI, use of #AI in #healthcare, pros & cons, its reliability, and so on. Only in the last week, the number of articles, white papers I have come across and read is more than 10, and yet that's being quite selective. Otherwise, the number will reach to 100+.

But there is one point that we are missing here. Before we start talking about the impact of artificial intelligence and how the health-care data is processed and (re)produced/(re)generated/manipulated/enhanced/interpreted by AI, we shall be talking about IF we are at the point where all digital healthcare tools are already implemented and in use, our hospitals are already running with the support of variety of clinical health-tech solutions other than HIS and EHR/EMR systems in the hospitals? Shouldn't we take one step back and first talk about clinical decision support systems, patient monitoring systems, chronic disease management, post-discharge acute care tools, and many other things before we dive into the AI space?

Digitization in the hospitals and clinics for all levels of care is essential and inevitable. And not only from the patient records perspective, or digital appointments, virtual consultations. And when it comes to #criticalcare, the importance and benefits of implementing digital healthcare tools and health-tech solutions are somehow underrated.

Critical care is a race against time

Time is of essence already in patient care and all areas of medicine. It's important to do what needs to be done in a timely manner to produce the best treatment outcomes. When it comes to "critical" care, "intensive" care, the importance of doing everything timely increases by folds. There is no room for waste of time and efforts, especially considering that the shortage of qualified staff for critical care is almost a global issue. Every second counts. Every piece of information is valuable, important, critical.

One army, many battlefields

Lab results arriving. Alarms coming from devices. Additional consultation requests to be followed up. Changing medication to be updated. Patient care tasks to be performed. Escalating patient conditions. Too many readings to note down. And so many other things to be done by the ICU/CC nurses, and so many things to catch up and coordinate timely.

All the manual administrative work and paperwork to be done becomes an enemy to the clinical team as well as to the patient. Documenting patient care, updating patient's medical records, completing charts, scales, calculating scores, and the need for doing all and more of these sort of tasks with precision while trying to "save" lives of the patients with acute critical conditions is a massive job. It becomes frustrating, is open for human error, and brings other problems that overall affects the quality of care, mortality rate, length of stay, and the economics.

• Nurses spent average 27% of their time for documentation and paperwork (2016, Journal of General Internal Medicine)
• ICU nurses spent approximately 35.5% of their time on documentation and administrative tasks (2018, American Journal of Critical Care)
• Studies show EHR can save up to 25% of nurse's time that she can use for direct patient care. (American Journal of Critical Care)

The burden and the risk

Some of the risks when there are no digital tools in place for paperwork and administrative tasks are the following:

• Delayed Care and Response Time: occupied with documentation and filling up forms, nurses may fall behind the schedule, and it may introduce delays in performing care plan tasks. This can impact the treatment outcomes, if not also may introduce risks to the patient safety in the ICU settings.
• Burn-out and dis-satisfaction: The pressure in the critical are is already high. Added up the massive amount of paperwork and administrative tasks that needs to be done manually leads to frustration, increased pressure, and finally brings dis-satisfaction and causes burn-out.
• Difficulty of care coordination: Effective communication is important. Having papers around filled in with incomplete information may mis-guide the next nurse in the shift, may cause intensivist to skip an important detail because it was not clearly readable on the paper, if not the small note paper has not already been lost. This creates gaps.
• Risk of human error and omission: Trying to finish all the paperwork so that the patient care could be resumed, rushing to fill up the forms with readings and measurements, calculating the ICU scores introduces the risk of error. Some readings may be skipped, some may be entered unintentionally wrongly, some could not be read by the next shift clinical team members caused by some bad handwriting, or may be a spilled coffee drop.
• Alarm fatigue: Many patient rooms, many medical equipment, and so many sounds (alerts, notifications, operational sounds, beeps, buzzes, ...) and yet there is no time just to spare the moment to distinguish, analyse, and act on these sounds. We adopt to environmental conditions quite fast. When it's too hot, we sweat for some time, then our body adjusts. Most of us can sleep even though the sound of the TV is too loud, or the light in the room is too bright. We work with precision while the construction yard next to the office is at full speed with industrial machinery operating. And then how about in the ICU? Nurses may not hear some alarms, or simply may have ignored the sound without even knowing, and for some time such may stay unattended. Yes, most of the time, there are centralized patient monitors at the nurse desk, but is it enough? Is it only limited to vital signs coming from the monitors, but not from the pumps, or ventilators?

The more digital, the better

Starting with implementation of digital patient health records, continuing with bed-side integration, centralization of medical devices and recording the readings coming from them automatically, bringing all alarms and notifications into the nurse station, even to their mobile phones and helping them to get rid of the burden of filling forms and charts, writing down the measurements and readings that are already available in a digital form will lead to reducing (if not completely removing) the above mentioned risks. Here are some positive outcomes achieved by implementing digital healthcare tools and health-tech:

• 30% decrease in response time for critical lab results by implementing a mobile communication system in the ICU (Journal of Intensive Care Medicine)
• Up to 86% reduction in medication errors when CPOE (computerized physician order entry) systems are deployed (Journal of Critical Care)
• 49% reduction in mortality rates for patients on mechanical ventilation after the implementation of a clinical decision support system in the ICU. (Journal of the American Medical Informatics Association)

And yet, above are just a few samples among many outcomes that have an improving impact on the quality of care, length of stay, employee satisfaction and happiness, reduction in cost of care, etc.

Digitization and digital transformation is a journey for all industries and is continuous. We need to consider the long-term benefits of implementing health-tech and digital healthcare platforms rather than their short-term costs on finance and time for implementation of such.

Diginova Health Solutions may help you to build, execute, fine-tune digital healthcare and transformation strategy, and walks together with you through the entire journey.

ARC Digital ICU Solutions LLC brings you a fully digital and AI-supported ICU platform, that works in harmony with the HIS/EMRs.